Clinical Solutions

Amico Clinical Solutions

Submittal Package

Prepared For: Date: PO # Quote #

Indura Medica July 12, 2012 204970 A8097

Approved By: __________________________ (Print)

Approved By: __________________________ (Signature)

Clinical Solutions
Contact Verification ......................................................................................................................................................... 1 Project Overview ............................................................................................................................................................... 2 System Verification Summary ........................................................................................................................................... 3 Systems Drawings ........................................................................................................................................................ 4-11 Equipment Mounting Plate Orientation ......................................................................................................................... 12 Medical Gas Outlet Type, Standard & Language Verification ......................................................................................... 13 Shipping Information ...................................................................................................................................................... 14 Terms and Conditions ..................................................................................................................................................... 15 Warranty Policy .............................................................................................................................................................. 16

CONTACT INFORMATION PAGE

Dear: ____________________________________________ At Amico, your project remains our top priority at all times. We look forward to working with you in bringing you the most efficient, state-of-the-art medical equipment for your facility. We hereby present you with our team of experts:

Amico Clinical Solutions Team

Title Director of Service & Installations Project Manager Director of Sales Contact Person Phil Barlow Fenil Patel Julia Elner Telephone (416) 996-9512 (905) 764-0800 Ext. 5709 (877) 683-0248 E-mail pbarlow@amico.com fpatel@amico.com jelner@amico.com

Please fill in your contact details below to better assist us in providing you our first class service. Title General Contractor Architect Contact Person Telephone E-mail

Hospital Contact

Head Plumber

Head Electrician

Other

PHASES
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PROJECT OVERVIEW
Purchase order received and reviewed by Amico Clinical Solutions (ACS) Submittal package assembled Preliminary Production schedule is developed SIGNED Submittal package returned to ACS Pre-Installation Package sent out for initial review by the General Contractor or Hospital Finalize Production Schedule Note: Production does not commence until signed submittal is received and confirmed by an Amico Clinical Solutions representative Shipment of Pre-Installation Kit (Include: Anchor Plates, Gas Risers, Gas Riser Brackets, and Electric Brake Power Supply) Note: Shipment of parts indicated above is subject to change depending on your current project. Parts will not be shipped until signed submittal is received. General Contractor and Amicos National Maintenance & Service Manager discuss the PreInstallation requirements and sign-off on pre-installation package The Hospital or The General Contractor installs Pre-Installation Kits and completes all pre-installation requirements as stated previously Shipments of Medical Equipments are dependent upon ACS Production Schedule. Amico Clinical will work closely with the hospital to ensure timely delivery Note: There is an approximate of 10 12 weeks lead time subsequent to received submittal Installation as scheduled with Amicos General Contractor & National Maintenance and Service Manager Note: Installation commences ONLY if installation services are purchased from Amico and all preinstallation requirements are met In-Service Training Final Sign-off and Warranty Project Follow-up: Preventative Maintenance Contracts

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SYSTEM VERIFICATION SUMMARY

SYSTEM A ROOM TYPE: _________________________________

Configuration

LP-L-1N1N-N

Quantities

07

Drawing #

18

Tandem configuration consisting of two (2) 1000 mm low profile arms, with wired C40 service consoles.

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ANCHOR PLATE ORIENTATION

VERTICAL
QUANTITIES

_________________________________________

HORIZONTAL QUANTITIES

_________________________________________

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MEDGAS OUTLETS
PLEASE SELECT REQUIRED STANDARD & LANGUAGE
CHEMTRON OHMEDA

US English US Spanish ISO English ISO Spanish

US English US Spanish ISO English ISO Spanish ISO French

PURITAN BENNETT

D.I.S.S

US English US Spanish ISO English ISO French

US English US Spanish ISO English ISO French

OXEQUIP / MEDSTAR

BRITISH STANDARD

US English US Spanish ISO French ISO English

PASSIVE WAGD / AGSS

IMPORTANT INFORMATION / SPECIAL REQUEST

ISO French US Spanish ISO English

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HOSPITALS SHIPPING INFORMATION

Shipping Contact(s)

Shipping Address Hours of Delivery Floor & Room Locations

Trailer Height Capacity

Storage Facility

o Elevated o Ground Level

Receiving Dock Type

o YES o NO o Pump Truck o Fork Lift

Lift Gate YES NO

Equipment Transports

AMICO CLINICALS PACKING TYPE

o Crate o Skid
Packing Type Size/Dimensions: 48 x 30 x 48 Weight: 9750 lbs

o Boxes

Quantity: 15 Skids

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TERMS AND CONDITIONS

1. The hospital and/or approval authority is responsible for verifying the medical gas outlets will meet and/or exceed the requirements of NFPA 99 (most recent edition). ACS will provide gas risers with serviceable check valves for Amicos boom system. However, it is the responsibility of the hospital to supply the required quantity of shut-off valves for each specific gas source for Amicos boom. It is the responsibility of the client to provide on-site connections for gases, fittings, and junction boxes for all control and power wiring. The hospital and/or approval authority is responsible for scheduling a licensed electrician onsite to complete all electrical wirings (between boom and junction box). ACS must have the pre-installation package reviewed and completed by the on-site contractor before installation procedures can commence. Ceiling Pendant/Light Fixtures will be built as per ACS design and dimensions specified in this package (all tubing and wiring will be completed and operationally tested prior to shipment).All electrical receptacles are factory wired according to circuits indicated in shop drawings. (Changes/alterations must be identified in this submittal and will only be included at the discretion of ACS). Approval signature(s) are mandatory and are required on all drawings. (Production will not commence without signed drawings). Standard lead time is 10 12 weeks after receipt of approval of signed submittal and shop drawings. Any delays in returning the approved submittals or returning them with incomplete or inaccurate information will cause delay in delivery or possible incompatibility of electrical and mechanical services.

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8. ACS will not be held responsible for ANY damages as a result of unauthorized modifications and/or substitutions made by the
client. (Unauthorized modifications/substitutions to Amicos factory standard components will be completed at the clients own risk and will void ALL warranty and service agreement between both parties). Notes: Amico provides equipment only (Installations are not included). Installation by ACS Installation Team may be purchased for an additional fee. Data Cable pulling and Anchor Plate installation may be purchased as optional packages. By signing this Submittal package in the area below, you, as the customer has agreed upon and accepted all terms and conditions specified above.

Signature: _____________________________________ Print Name: ____________________________________

Title: ____________________________________ Date: ____________________________________

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WARRANTY POLICY

1.

ACS warrants its materials and workmanship to be free from defects for a period of twelve (12) months from the date of installation. Within this period, ACS will repair and/or replace any part on site or at the factory, which has proven to be defective at ACS costs. ACS will warrant its material to be free from defect for an additional period of four (4) years, five (5) years from the date of installation. Within this period, ACS will replace any part (at no additional charge), which is deemed defective. Shipping and installation costs after the first twelve (12) months will be borne by the customer. ACS will warrant its Pearl Series LED Lights, Monitor Arms & Patient Lift Pendant to be free from defect for a period of two (2) years from the date of installation. Within this period, ACS will replace any part (at no additional charge), which is deemed defective. Shipping and installation costs after the first twelve (12) months will be borne by the customer. This warranty is valid only when the product has been properly installed as outlined in The ACS specifications; including but not limited to proper usage and servicing of systems according to factory recommendations. It does not cover damages as a result of shipment failures, accidents, misuse, abuse, neglect, mishandling, alternation, misapplication or damages which may be attributed to acts of God. ACS shall not be liable for incidental or consequential damages resulting from the use of the equipment. All claims for warranty must first be approved by ACS Service Department (service@amico.com or 1-877-4626426). A valid Return Goods Authorization (RGA) number must be obtained from ACS prior to commencement of any service work. Warranty work which has not been pre-authorized by ACS will not be reimbursed.

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